Investigation of Quality of Life Determinants in Children with Food Allergies.

BACKGROUND: Food allergy (FA) in children impacts their own and their family quality of life (QoL). The association of specific FA factors with the various domains of health-related QoL (HRQL) in children is unclear. OBJECTIVE: The aim of this study was to evaluate FA characteristics in primary school children as determinants of components of HRQL. METHODS: Children with FA were recruited from the allergy clinic of a tertiary children's hospital. Demographic and clinical data were retrieved from their records, and 3 HRQL questionnaires were administered: the FA QoL Questionnaire-Child Form (FAQLQ-CF), the FA independent measure (FAIM), and the Pediatric QoL Questionnaire (PedsQL™). Stepwise multiple linear regression analysis was carried out to investigate the correlation between FA characteristics and the scores on the HRQL scales. Bonferroni correction for multiple comparisons was set at p < 0.0002. RESULTS: Of 172 primary schoolchildren with FA invited to take part, 110 participated (response rate 64%), of whom 83 (75.5%) were male, aged 7.5-12.3 years (mean 10.0 ± 1.4) years. From 38 demographic and clinical characteristics, 10 were excluded on initial data analysis and 28 proceeded to bivariate analysis with the scores on FAQLQ-CF, FAIM, PedsQL™, and their subscales. Most of the 28 showed no correlation with the scores; only 4 were entered into multivariate analysis with FAQLQ-CF and PedsQL™ scores, none of which, finally showed significant association. CONCLUSION: The HRQL of children with FA did not depend on gender, age, number, and type of allergen or the characteristics of the most severe allergic reaction.

Translation, Adaptation and Initial Validation of Food Allergy Quality of Life Questionnaire: Child form in Greek.

The aim of the study is to determine the reliability and validity of the Greek version of the Food Allergy Quality of life Questionnaire-Child Form (FAQLQ-CF). After linguistic validation, the Greek FAQLQ-CF, Food Allergy Independent Measure (FAIM) and Pediatric Quality of Life Inventory (PedsQL™) were used by a physician to interview children diagnosed with food allergy and aged 8-12 via telephone. Cronbach's alpha was used to evaluate reliability, and factor analysis to assess construct validity. The correlation between FAQLQ-CF and FAIM was moderate (rho=0.509, P<0.001) and internal consistency was strong (Cronbach's alpha 0.905). FAQLQ-CF discriminated well each question's contribution to children's quality of life deterioration (32-80%), each child's quality of life (17-89%), children differing in doing things with others (total score 3.55 vs 2.57, difference =0.98 > minimal clinical importance difference = 0.5; P<0.001), but not children differing in reporting anaphylaxis. The total FAQLQ-CF score correlated with the total PedsQL™ score and with the score of one of PedsQL™ subscales, demonstrating convergent validity. Factor analysis uncovered an underlying structure of four factors, explaining 50% of the variance. We can conclude that Greek FAQLQ-CF is a reliable, valid, discriminant tool for interviewing food allergic children aged 8-12, detecting those in need for immediate care.

Validation of the Postgraduate Hospital Educational Environment Measure (PHEEM) in a sample of 731 Greek residents.

BACKGROUND: The Greek version of the Postgraduate Hospital Educational Environment Measure (PHEEM) was evaluated to determine its psychometric properties, i.e., validity, internal consistency, sensitivity and responsiveness to be used for measuring the learning environment in Greek hospitals. METHODS: The PHEEM was administered to Greek hospital residents. Internal consistency was measured using Cronbach's alpha. Root Mean Square Error of Approximation (RMSEA) was used to evaluate the fit of Structural Equation Models. Content validity was addressed by the original study. Construct validity was tested using confirmatory (to test the set of underlying dimensions suggested by the original study) and exploratory (to explore the dimensions needed to explain the variability of the given answers) factor analysis using Varimax rotation. Convergent validity was calculated by Pearson's correlation coefficient regarding the participant's PHEEM score and participant's overall satisfaction score of the added item "Overall, I am very satisfied with my specialization in this post". Sensitivity was checked by comparing good versus poor aspects of the educational environment and by satisfied versus unsatisfied participants. RESULTS: A total of 731 residents from 83 hospitals and 41 prefectures responded to the PHEEM. The original three-factor model didn't fit better compared to one factor model that is accounting for 32% of the variance. Cronbach's α was 0.933 when assuming one-factor model. Using a three-factor model (autonomy, teaching, social support), Cronbach's α were 0.815 (expected 0.830), 0.908 (0.839), 0.734 (0.793), respectively. The three-factor model gave an RMSEA value of 0.074 (90% confidence interval 0.071, 0.076), suggesting a fair fit. Pearson's correlation coefficient between total PHEEM and global satisfaction was 0.765. Mean question scores ranged from 19.0 (very poor) to 73.7 (very good), and mean participant scores from 5.5 (very unsatisfied) to 96.5 (very satisfied). CONCLUSIONS: The Greek version of PHEEM is a valid, reliable, and sensitive instrument measuring the educational environment among junior doctors in Greek hospitals and it can be used for evidence-based SWOT analysis and policy.

Interprofessional/multiprofessional health professions education: designing an efficient search to scope the literature of this exploding field.

BACKGROUND AND OBJECTIVE: With the advent of an interprofessional approach to delivering health care in today's health care systems, should health care professionals be educated together? Supported by policy-making circles worldwide, interprofessional education is accumulating a research literature at an exponential rate. Using one-word search terms in the MEDLINE query box for scoping this body of literature, we obtained an unmanageable number of articles (342 338 in all fields). The objective of our study was to outline an efficient specific query. METHODS: We created 1072 phrasal search terms consisting of a prefix, an adjective and a noun. Of those, 66 were prolific for the whole indexed period (1950-2006). RESULTS: Only 2510 citations have the search term in all MEDLINE fields; of those 2049 were in title/abstract and 652 in title alone. From the 1950s, the citations were published at a slow rate, but the rate then exploded during the decade 1995 to 2006. The combination of prefixes 'inter' and 'multi' with the adjectives 'professional', 'disciplinary' and 'shared', and the nouns 'education', 'learning' and 'training' may retrieve almost all the relevant citations, while the terms 'collaborative' and 'common' may retrieve mainly irrelevant ones. The adjective 'cohesive' and nouns 'practice' and 'role' should be also considered. CONCLUSION: Phrasal search terms highly increased the relevance of MEDLINE-retrieved citations.

Self-reported health in high and very high incomes.

The objective of the present study was to investigate whether self-reported health (SRH), an overall health indicator, continues to improve as individual income increases to very high levels or whether there is a threshold above which this relationship changes direction. We used data from the 2003 US Current Population Survey, focusing on the upper income decile. We modelled the relationship between income and SRH before and after adjustment for other socio-demographic parameters that are known to influence SRH. In the unadjusted model, SRH increased with increasing income up to the threshold of $326,000, above which SRH declined. After adjustment for all major socio-demographic parameters (age, gender, race, education, and marital status), the adjusted curve showed monotonically increasing SRH with increasing income. Adjustment for each of these parameters separately revealed that the threshold effect was lost only after adjusting for education. There were more people with low levels of educational attainment among those receiving more than $500,000 per year, compared to other people in the upper income decile. Increasing income does not always improve SRH. People in the very high income bracket tend to report slightly worse health, which may be explained by their lower education.

Multivariate models of self-reported health often neglected essential candidate determinants and methodological issues.

BACKGROUND AND OBJECTIVE: Self-reported health is an important indicator of overall well-being that may be influenced by diverse parameters. We intended to evaluate the variety of candidate determinants used in models of self-reported health (SRH) and to examine the methodological problems encountered in multivariate models used in recent studies in this field. STUDY DESIGN AND SETTING: Medline searches identified articles published in 2002 in which SRH was included as an outcome, at least one other variable was used as a determinant of SRH, and the study population was not defined by the presence of specific diseases. RESULTS: Of 1,991 initially identified reports, 56 were eligible. In 91% of the eligible articles, multivariate models were used. In total, 133 different determinants of SRH were considered (median 7 determinants considered per study with multivariate models). The proportions of studies with problems in multivariate modeling were: overfitting, 10%; nonconformity to a linear gradient, 29%; no report of tests for interactions, 63%; unspecified coding of variables, 49%; and unspecified selection of variables, 29%. CONCLUSION: Models that try to identify what influences SRH should consider appropriate lists of candidate determinants, with proper attention to methodological aspects of multivariate modeling.